Association of dietary patterns with chronic respiratory health among U.S. adults

Respiratory health is closely related to immune system function, and diet can also influence immune homeostasis. Diet, an important part of a healthy lifestyle, is also linked to respiratory health. We aimed to explore the relationship between different dietary patterns and the risk of chronic respiratory diseases (CRDs), including chronic bronchitis (CB), emphysema, and asthma.

A total of 23,042 adults from the United States were selected from the National Health and Nutrition Examination Survey (NHANES) dataset between 2007 and 2018. Diet quality was assessed using 2-day, 24-hour dietary recall data and quantified as the Healthy Eating Index-2020 (HEI-2020), the Dietary Inflammation Index (DII), the Mediterranean Dietary Index (MEDI), and the Dietary Approaches to Stop Hypertension Index (DASHI). Binary logistic regression models, restricted cubic splines (RCS), and the weighted quartile sum (WQS) models were used to assess the relationship between diet quality and the risk of CB, emphysema, and asthma.

In logistic regression analyses of the four dietary indices with the three chronic respiratory diseases, it was consistently observed that higher dietary quality scores were linked to a reduced risk of respiratory disease. These consistent trends were also evident in the assessments of the dose-response relationship between dietary quality score and the risk of respiratory disease. Furthermore, evaluations of the combined effects of dietary components across different dietary indices in the risk of chronic respiratory disease yielded results consistent with the logistic regression models. Notably, high-quality protein, minerals, and fiber-rich fruits and vegetables emerged as the food groups making the most significant contributions to health across different dietary indices.

Low-quality diets, lacking in high-quality protein, minerals, and fruits and vegetables rich in dietary fiber, are associated with a higher risk of chronic respiratory disease, regardless of the dietary index used to measure diet quality.